Principles for the OhioCare Plan for 2019
Health care ought to be a basic right in a democratic society. The affordability and availability of health care is essential to the quality and length of life. Any society worthy of the support of its people ought to provide health care for all. The fact that quality health care is generally available depending on income compromises our humanity, makes health care peons of hardworking Americans, and drives millions of people to the brink of poverty and hampers economic growth by placing a financial burden on small businesses.
Imagine a health care system which contributes to the health of all of its people, the prosperity of its businesses and industries, and is not hamstrung by insurance companies.
I know about the health care system, not simply because years ago I worked in it as an orderly, then a surgical technician, but because I was a frequent client of it, as I struggled with Crohn’s Disease for much of the first fifty years of my life. I had frequent surgeries, life-threatening crises, frequent cases of painful inflammatory episodes controlled only by large doses of various pharmaceuticals. Pain was my constant companion. I imagine that today my journey would cost the health care system several millions of dollars.
But in 1995, I took a different path. I took charge of my own health. I changed my diet to vegan. I added Chinese herbal medicine. Today I am no longer afflicted with Crohn’s and enjoy the greatest vitality, with no emergency visits, no pain and no financial burden from co-pays and deductibles. I would call my experience a journey into the power of regenerative medicine. And it is not my journey alone. It is a journey being taken by millions of Americans who are striving to take control of their own health, their own lives, their own destiny. I know from my own experience in changing my diet that one does not have to face deteriorating health with age.
Consider today that the most common non-communicable diseases such as heart disease or diabetes are complicated greatly by poor nutrition.
We need an integrated public policy that not only addresses how we provide and pay for health care coverage but ensures that people know how to take care of their health, including nutrition education, access to healthy food, reducing exposure to toxic pollutants, stress management and a host of options which lead to improved health, cost efficiency and the direction of health care dollars to health care itself.
A study by the Commonwealth Fund in 2015 found that the “US spends more on health care than other high-income nations, but has a lower life expectancy, and worse health.” The Commonwealth Fund study determined that “Americans have fewer doctor and hospital visits than people in other nations; outsized spending likely the result of more technology, higher prices for care and prescription drugs.”
“The United States spends almost twice as much on health care, as a percentage of its economy, as other advanced industrialized countries – – totaling $3.3 trillion or 17.9 percent of gross domestic product in 2018,” according to an article in the New York Times, published at the beginning of this year.
This year, the Guardian newspaper wrote that “The US is the most expensive nation in the world in which to have a baby – and it may factor into thousands of bankruptcies each year.” One estimate is that 56,000 American families go bankrupt every year, as they pay the medical costs associated with a new baby. The report related that the US “consistently ranks poorly in health outcomes for mothers and infants.” For some inner-city Ohio families in high poverty areas, infant mortality has risen to one of the highest levels in the United States.
I am proposing an OhioCare plan guided by the following principles, consistent with HR 676, Medicare for All, a bill which I wrote and introduced, in partnership with Rep. John Conyers (D-MI) Section 1332 of the Affordable Care Act encourages states to pursue universality, with health care for all Ohioans, and not for some.
- It shall be a not-for-profit, single payer system. One fund, one plan and one single payer, because it is the simplest and most efficient approach to the administration of health care resources. This does not mean government-run hospitals and long lines. It means there is one agency or organization within state government paying the bills and enjoying the reduced costs by cutting out middlemen.
- Every single Ohioan will be covered. Having all Ohioans in the same group will insure that coverage for all at the lowest possible price. A single payer system will not be free, but through the elimination of the profit incentive, through cutting out waste, fraud, abuse and overcharges, by introducing careful analysis of where the greatest cost burdens are in the system, and by taking steps to improve health outcomes through primary care, we can dramatically drive down costs and insure that the expense involved will be dramatically reduced.
- Ohioans will no longer have to worry about paying expensive premiums, copays and deductibles to health insurers.
- Patients will be able to have the doctor of their choice.
- Doctors would be paid on a fee-for-service basis within 30 days, without having to deal with for-profit. Insurance companies prolong deliver of payments to doctors or fight to reduce the fee owed.
- Doctors and nurses’ and medical industry staff jobs will become secure and the focus will be on caring for people, not having to worry about cutting patient services or taking time to administer for-profit insurance paperwork,
- Providers must be not-for-profit. Private entities such as physicians and clinics cannot be owned by investors.
- For-profit insurance companies make money not providing health care. In a not-for-profit system, health care dollars will be spent on health care.
- For-profit insurers will be able to sell insurance to provide coverage for anything not covered by OhioCare, but under no circumstances will they be able to duplicate OhioCare
- Our OhioCare plan will emphasize prevention diet, nutrition, complementary medicine, and wellness at every age group.
- System funding will be based on principles of health care cost analysis and efficiency.
What will be covered under OhioCare:
- All medically necessary care, including primary care and prescription medicine.
- In-patient care.
- Out-patient care.
- Obstetrics, pre-natal and post-natal care.
- Reproductive health care.
- Emergency care
- Mental health
- Vision care
- Auditory care, including hearing aids
- Podiatric care
- Addiction treatment
- Diet, and nutritional counseling.
- Complementary medicine, including acupuncture and chiropractic service.
Cost Reductions, Analysis, Controls and Savings
- Reduction of cost of administrative services (18%) per Dr. Robert Polan studies.
- Estimated reduction of cost of corporate profits, stock options, executive salaries, advertising and marketing (12%)
- Negotiation of prescription drug prices
- Negotiation with providers based on Medicare rates.
- Pay hospitals global budgets so that hospitals have money for core services.
- Eliminate mark-ups which now range from 300% to 400%
The same New York Times article cited earlier said this about a single-payer system. “A single payer system could also regulate prices. If attempted nationally, or even in a state, either of these would be met with resistance from all those who directly benefit from high prices….”
As a matter of public policy, we need a cohesive, non-fragmented system. Market forces are siphoning off funds. The OhioCare plan will help pull all systems together, dramatically reducing costs while significantly improving outcomes.
I have spoken with leading clinicians and health care finance experts and have learned that a recent Dartmouth-Mayo Clinic study has studied Medicare data, census data and clinical data and can predict those patients which are the most expensive to the system. Some of the factors under study include 1) the co-occurrence of additional diseases; 2) The functional status of the patient, i.e., whether they can walk up two flights of stairs. 3) Social deprivation factors.
Five percent of patients with complex illness account for 50% of money spent in health care. Five percent. The effective ability to change that depends upon interaction with organized teams which are physician-led and physician-based. Behind the high cost patients is a combination of chronic disease significant frailty and social needs, Corporate models do not address where the costs are. Let me briefly review some of those costs:
1) end of life palliative care; 2) multiple chronic illnesses revealing gaps between the social system and the medical system; 3) individuals who have catastrophic illness or chronic disease
Health care financing experts are now analyzing the variation in cost for high cost patients and developing a model health care program for the very sick. The most expensive patients present to the medical system with a range of identifiable problems, including functional limitations and social needs. A new system of care must be created for them, rather than averaging them into the overall costs. A new health care system in Ohio must consider both the structure of care appropriate to patients within the context of the structure of financing the system. Once we are able to predict which patients are likely to be a significant cost to the system, through prevention some of those costs can be reduced and used for regular care.
For very ill patients, the costs and the outcome is better if they are cared for in an integrated system. Primary doctors know them and have a relationship with them. This is a continuity of care model. A disintegrated model drives costs up an estimated 30%.
A few additional points underscoring the wide-ranging benefits of the plan I’ve detailed here:
- This plan will lower workers comp rates by cutting out the profiteering Managed Care Organizations (MCOs) that are stealing small business and injured workers money.
- Reduced insurance costs will give Ohio a huge advantage in attracting jobs.
- This will dramatically reduce the disproportionate and corrupting influence that the for-profit health care industry – insurance companies, nursing homes, MCO’s, and others – have on the General Assembly through lobbying and lobbyists money.
Ohio can become a national leader in health care for all by addressing an integrated system, sharply reducing costs, and expanding health care for all through a single-payer, not-for profit-system, and I am prepared to lead the way.
One final point: If the Ohio General Assembly will not work with me to enact this plan for the benefit of all Ohioans, I will take this issue to the ballot in 2020 – a Presidential election year, by the way — and ask the voters to exercise their rights and demonstrate their power to enact changes that are in the public interest.